Regenerative interventional treatment of hip and knee joint aseptic necrosis: evaluation of effectiveness

To evaluate the safety and efficacy of gabapentin and venlafaxine in the treatment of painful diabetic neuropathy in patients whose pain did not improve with gabapentin monotherapy. (1) A randomized, double-blind, placebo-controlled, 8-week clinical trial comparing gabapentin versus placebo to define a patient population whose pain did not improve with monotherapy; (2) a second 8-week trial comparing gabapentin plus venlafaxine with gabapentin plus placebo; (3) a third uncontrolled 8-week trial of patients who did not improve on gabapentin monotherapy and then received venlafaxine in addition to gabapentin. (1) Gabapentin-treated patients showed statistically significant improvement in pain reduction as well as improvement in quality of life and mood disturbance when compared with placebo-treated patients; (2) patients who received gabapentin plus venlafaxine showed significant improvement in pain reduction, mood disturbance, and quality of life when compared with patients treated with gabapentin plus placebo; (3) patients who received gabapentin plus venlafaxine showed significant improvement in pain reduction, mood disturbance, and quality of life. (1) Gabapentin is efficacious in the treatment of painful diabetic neuropathy; (2) and (3) in patients who do not respond to gabapentin monotherapy, the addition of venlafaxine is also efficacious.

Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, which characterizes the development of the skeleton in an individual and can be used as a biomarker of regenerative potential in children and adolescents, which significantly affects the choice of treatment tactics for diseases of the hip and knee joints. In particular, we have established the dependence of reparative regeneration processes in children and adolescents on skeletal maturity in such diseases of the hip and knee joints as slipped capital of femoral epiphysis (SCFE), Perthes’ disease, femoro-acetabular conflict syndrome, spastic hip dislocation in patients with cerebral palsy, Blount’s disease. The intensity of regeneration processes in the prepubertal development allows the use of less invasive methods of surgical interventions. The purpose is to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The group for the development of the examination methodology consisted of 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and without diagnosed hip joint pathology) and 129 patients (58 boys and 71 girls) with knee joint diseases (Blount disease, axial deformities of the lower extremities, meniscal damage and patients who were examined for complaints of pain in the knee joint area) aged 10 to 18 years. The group of a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes’ disease, Blount’s disease, the pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, as it characterizes the development of the skeleton in an individual and can serve as a biomarker for regenerative potential in children and adolescents. This assessment significantly influences the choice of treatment tactics for diseases of the hip and knee joints. Specifically, we have established a correlation between reparative regeneration processes and skeletal maturity in conditions such as slipped capital femoral epiphysis (SCFE), Perthes' disease, femoroacetabular impingement syndrome, spastic hip dislocation in patients with cerebral palsy, and Blount's disease. The intensity of regeneration processes during prepubertal development allows for the use of less invasive methods of surgical interventions. The purpose of the study was to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The study group for the development of the examination methodology included 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes' disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and individuals without diagnosed hip joint pathology), as well as 129 patients (58 boys and 71 girls) with knee joint diseases (Blount's disease, axial deformities of the lower extremities, meniscal damage, and patients who were examined due to complaints of knee joint pain), aged between 10 to 18 years. The group for a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes' disease, Blount's disease, and pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Conclusions. In the prepubertal period, we recommend the use of regenerative technologies in combination with one of the risk factors or in cases with a severe or moderate course of the disease. During the induction of puberty, regenerative technologies are recommended in the presence of one of the risk factors or in cases with a severe or moderate course of the disease. In the pubertal period, due to the reduction of the individual's regenerative potential, we recommend the use of regenerative technologies for all patients.

ObjectiveTo explore the effects of proximal fibular osteotomy as a new surgery for pain relief and improvement of medial joint space and function in patients with knee osteoarthritis.MethodsFrom January 2015 to May 2015, 47 patients who underwent proximal fibular osteotomy for medial compartment osteoarthritis were retrospectively followed up. Preoperative and postoperative weight-bearing and whole lower extremity radiographs were obtained to analyse the alignment of the lower extremity and ratio of the knee joint space (medial/lateral compartment). Knee pain was assessed using a visual analogue scale, and knee ambulation activities were evaluated using the American Knee Society score preoperatively and postoperatively.ResultsMedial pain relief was observed in almost all patients after proximal fibular osteotomy. Most patients exhibited improved walking postoperatively. Weight-bearing lower extremity radiographs showed an average increase in the postoperative medial knee joint space. Additionally, obvious correction of alignment was observed in the whole lower extremity radiographs in 8 of 47 patients.ConclusionsThe present study demonstrates that proximal fibular osteotomy effectively relieves pain and improves joint function in patients with medial compartment osteoarthritis at a mean of 13.38 months postoperatively.

Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services.

Objective. To characterize periprosthetic joint infection in patients undergoing a total hip and knee joint replacement. Materials and Methods. A total of 77 patients with periprosthetic infection following hip and knee joint replacement hospitalized in Grodno City Clinical Hospital were studied over the period of 2014-2018. Wound discharge, tissue samples, and fistula’s wall swab were used for microbiological tests. The analysis of surgical treatment of patients with deep periprosthetic knee and hip joint infection has been performed. Results. Periprosthetic infection after hip joint arthroplasty was observed in 32 (41.6%) patients, and after total knee joint arthroplasty in 45 (58.4%) patients. Surgical treatment was performed in 18 (56.3%) and 32 (71.1%) patients with periprosthetic infection following total knee and hip joint replacement, respectively. A total of 10 (31.2%) of 32 cultures from patients with periprosthetic infection after total hip joint replacement and 8 (17.8%) of 45 cultures from patients with periprosthetic infection after total knee joint replacement were positive. Overall, Staphylococcus aureus was detected in 9 (50%) of 18 positive cultures. Gram-negative aerobic bacteria (Acinetobacter baumannii, Klebsiella pneumoniae Pseudomonas aeruginosa) were detected in 4⁄10 and 5⁄8 of positive cultures from patients with periprosthetic infection of hip and knee joints, respectively. Conclusions. The most common pathogens causing periprosthetic infection of hip and knee joints were S. aureus (50%) and Gram-negative bacteria. The surgical treatment was performed in 71.4% of patients with periprosthetic joint infection.

Background: Pain originating in the facet joint accounts for an estimated 15%–45% of cases of low back pain. Radiofrequency ablation (RFA) of the medial branch nerves (MBN) is used in refractory cases. However, very few studies have compared the clinical outcomes of cooled versus conventional/traditional RFA (T-RFA) for the treatment of lumbar facet joint pain. Objective: To determine the clinical outcomes of MBN cooled RFA (C-RFA) compared with T-RFA, as measured by improvements in pain and physical function. Methodology: Forty patients with positive diagnostic MBN blocks were allocated to C-RFA or T-RFA group. Reduction in pain (NRS “Numerical Rating Scale” score), improvement in quality of life (Oswestry Disability Index [ODI]), proportion of responders/successful treatment (≥50% NRS reduction, and or ≥30% or ≥15 point reduction in ODI at 6 months follow up) in the two groups were recorded. Results: Total 34 patients were analysed, C-RFA (n = 18) and T-RFA (n = 16). There was significant reduction in pain scores as well as improvement in quality of life in both the groups, but the difference between the two groups was not significant. NRS reduction of ≥50% was observed in 72.22% and 68.5% of participants in the C-RFA and T-RFA groups, respectively (P = 0.824). A ≥15-point or ≥30% reduction in ODI score was observed in 77.77% and 75% of participants in the C-RFA and T-RFA groups, respectively (P = 0.849). Conclusions: Both the groups showed significant improvement in pain scores and quality of life. C-RFA resulted in greater treatment success rate than conventional RFA, but the difference was not significant.

(1) Background: Osteoarthritis (OA) significantly impacts patients' quality of life and negatively affects public healthcare costs. The aim of this systematic review is to identify the effectiveness of pulsed electromagnetic fields (PEMFs) in OA treatment across different anatomical districts, determining pain reduction and overall improvement in the patient's quality of life. (2) Methods: In this systematic review following PRISMA guidelines, PubMed and Google Scholar were searched for randomized controlled trials involving patients with osteoarthritis undergoing PEMF therapy. Seventeen studies (1197 patients) were included. (3) Results: PEMF therapy demonstrated positive outcomes across various anatomical districts, primarily in knee osteoarthritis. Pain reduction, assessed through VAS and WOMAC scores, showed significant improvement (60% decrease in VAS, 42% improvement in WOMAC). The treatment duration varied (15 to 90 days), with diverse PEMF devices used. Secondary outcomes included improvements in quality of life, reduced medication usage, and enhanced physical function. (4) Conclusions: Diverse PEMF applications revealed promising results, emphasizing pain reduction and improvement in the quality of life of patients. The variability in the treatment duration and device types calls for further investigation. This review informs future research directions and potential advancements in optimizing PEMF therapies for diverse osteoarthritic manifestations.

This article describes a case series of total joint replacement in 4 patients with systemic lupus erythematosus affecting the hip and knee joints. The average age of patients at the time of arthroplasty was 34 years. All patients were female and all received glucocorticosteroid therapy at varying doses of 5 to 10 mg per day. At the debut of the lupus erythematosus system, median activity index was 10 points. In one patient, remission of systemic lupus erythematosus was induced by mycophenolate mofetil, in another, by azathioprine. In total, three total arthroplasty were performed for aseptic necrosis of the head of the hip joint and one more arthroplasty due to severe osteoarthritis of the knee joint. At the time of arthroplasty in one clinical case a complete remission of systemic lupus erythematosus was observed, in three patients there was an incomplete remission. All components of the endoprostheses were stable, with no signs of osteolysis.In all cases, as a result of arthroplasty, a good effect was noted with increase in the functional activity of the hip and knee joints and decrease in pain. None of the patients had a recurrence of systemic lupus erythematosus and development of postoperative complications (except for the need for blood transfusion).Our own experience indicates the potentially high efficiency and relative safety of total hip and knee arthroplasty in patients with systemic lupus erythematosus, including in cases of severe disease with unfavorable prognostic factors. To reduce the risk of postoperative complications (primarily thromboembolism, infections, late delayed neutropenia), total arthroplasty should be performed during the period of remission of systemic lupus erythematosus in conditions of control of comorbid conditions and close cooperation between rheumatologists and orthopedic surgeons.Key words: systemic lupus erythematosus, total arthroplasty, hip joint, knee joint, aseptic necrosis, mycophenolate mofetil, azathioprine.

Vascular specialist response to medicare evidence development coverage advisory committee (MEDCAC) panel on peripheral artery disease of the lower extremities.

One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study we introduce a new collaborative approach in the effective teaching of the knee and hip joint. In the present teaching model, anatomist, orthopedists and physical therapists present the anatomy of the hip and knee joint in small groups. Courses for the hip and knee joint were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize for the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joint. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for healthcare organization.

Exoskeleton is a walking assistance device that improves human gait cycle through providing auxiliary force and transferring physical load to the stronger muscles. This device takes the natural state of organ and follows its natural movement. Exoskeleton functions as an auxiliary device to help those with disabilities in hip and knee such as devotees, elderly farmers and agricultural machinery operators who suffer from knee complications. In this research, an exoskeleton designed with two screw jacks at knee and hip joints. To simulate extension and flexion movements of the leg joints, bearings were used at the end of hip and knee joints. The generated torque and motion angles of these joints obtained as well as the displacement curves of screw jacks in the gait cycle. Then, the human gait cycle was simulated in stance and swing phases and the obtained torque curves were compared. The results indicated that they followed the natural circle of the generated torque in joints with a little difference from each other. The maximum displacement obtained 4 and 6cm in hip and knee joints jack respectively. The maximum torques in hip and knee joints were generated in foot contact phase. Also the minimum torques in hip and knee joints were generated in toe off and heel off phases respectively.

Objective: To assess the results of correction of the shape and position of the greater trochanter of the femur (GTF) after surgical treatment of hip joint (HJ) pathology in children. Methods: A retrospective analysis of the results of surgical treatment of the GTF deformities in 70 children (46 boys and 24 girls) between 2 and 18 years old. The children were divided into several groups: 18 patients with deformities the GTF (pathological hip dislocation (PHD) and the consequences of osteomyelitis), 8 with avascular necrosis of the femoral head (ANFH), 33 with congenital hip dislocation and 11 with coxa vara. The results of the treatment were assessed in terms from 3 to 16 years with the help of clinical, biomechanical and radiological methods. Results: In 88.7 % of cases there was achieved an improvement in clinical, radiological, biomechanical marks characterizing the HJ state comparing to preoperative ones. So, the symptom of Trendelenburg disappeared or decreased, strength of the abductor muscles increased in average on 11–20 % in the cases of coxa vara and on 30-45% in cases of ANFH. Indicators statopodographic study had a clear tendency towards normalization. Radiographic characteristics of trochanteric component of the HJ were within normal limits for each patient. Based on the working classification of the deformations of the GTF developed a differentiated approach to surgical procedures on it was offered in view of multiplanar character, extent and rate of progression of deformation, as well as with etiological factor and age of the patients. The most favorable outcomes after 3 years or more after the operation were obtained in cases of ANFH and coxa vara, and the least favorable - in the group of children with consequences of inflammatory diseases. Conclusion: The diagnosis and correction of the shape and position of the GTF in children with pathology of the HJ deserves special attention, and the surgical treatment of these abnormalities allows you to get better anatomical and functional results.

When landing, eccentrically controlled hip flexion, knee flexion and ankle dorsiflexion contribute to energy absorption. A recent comparison (1) of ground reaction forces between landings onto one and two-legs suggest a lander alters technique to reduce the magnitude of forces imposed in different landing situations. Comparing the kinematics at the ankle, knee and hip joints is a preliminary step in understanding technique alterations utilized for different landing situations. PURPOSE To compare lower extremity joint kinematics between drop landings onto one and two-legs. METHODS Eighteen college age females, free of lower extremity trauma, volunteered as participants. In one session, ten successful trials of one- and two-leg landings from a 38 cm stool were performed in random order by each participant; instructions were to “land comfortably”. Position of the right hip, knee and ankle joints was calculated from a sagittal plane video recording (120 Hz) beginning before contact through to maximum joint position. Five kinematic variables (touch down angle, maximum angle range of motion, peak angular velocity, and time to peak angular velocity) were calculated for each joint for each trials. The subjects' 10-trial mean values for each kinematic variable was entered into a paired t-test (α=.05) to identify statistical differences. RESULTS At contact, participants exhibited a significantly more extended position at the knee and ankle joints during one-leg landings, but not at the hip joint. During a one-leg landing, significantly less range of motion (ROM) was utilized at the hip and knee joints but significantly greater ROM was utilized at the ankle joint; thus, a more extended position was present at the hip and knee at maximum joint flexion in a one-leg landing. Between contact and maximum joint flexion, significantly lower peak angular velocities were measured at all three lower extremity joints. There were no significant differences in times to minimal joint angle or time to peak joint angular velocity. The more extended positions measured during a one-leg landing may reflect balance considerations, while the lower angular velocity values suggest reduced energy absorption. CONCLUSIONS One leg landings are characterized by more extended joint positions and lower joint angular velocities. ACKNOWLEDGEMENT Jump Rope for Heart grant from the Illinois Association for Health, Physical Education, Recreation and Dance.

When landing, eccentrically controlled hip flexion, knee flexion and ankle dorsiflexion contribute to energy absorption. A recent comparison (1) of ground reaction forces between landings onto one and two-legs suggest a lander alters technique to reduce the magnitude of forces imposed in different landing situations. Comparing the kinematics at the ankle, knee and hip joints is a preliminary step in understanding technique alterations utilized for different landing situations. PURPOSE To compare lower extremity joint kinematics between drop landings onto one and two-legs. METHODS Eighteen college age females, free of lower extremity trauma, volunteered as participants. In one session, ten successful trials of one- and two-leg landings from a 38 cm stool were performed in random order by each participant; instructions were to “land comfortably”. Position of the right hip, knee and ankle joints was calculated from a sagittal plane video recording (120 Hz) beginning before contact through to maximum joint position. Five kinematic variables (touch down angle, maximum angle range of motion, peak angular velocity, and time to peak angular velocity) were calculated for each joint for each trials. The subjects' 10-trial mean values for each kinematic variable was entered into a paired t-test (α=.05) to identify statistical differences. RESULTS At contact, participants exhibited a significantly more extended position at the knee and ankle joints during one-leg landings, but not at the hip joint. During a one-leg landing, significantly less range of motion (ROM) was utilized at the hip and knee joints but significantly greater ROM was utilized at the ankle joint; thus, a more extended position was present at the hip and knee at maximum joint flexion in a one-leg landing. Between contact and maximum joint flexion, significantly lower peak angular velocities were measured at all three lower extremity joints. There were no significant differences in times to minimal joint angle or time to peak joint angular velocity. The more extended positions measured during a one-leg landing may reflect balance considerations, while the lower angular velocity values suggest reduced energy absorption. CONCLUSIONS One leg landings are characterized by more extended joint positions and lower joint angular velocities. ACKNOWLEDGEMENT Jump Rope for Heart grant from the Illinois Association for Health, Physical Education, Recreation and Dance.

Despite the established success of total knee arthroplasty (TKA) with end-stage osteoarthritis, there is a notable scarcity of research on its long-term outcomes in individuals suffering from end-stage Kashin-Beck disease (KBD). This retrospective study aimed to assess the long-term outcomes and effectiveness of clinical function, quality of life, and complications of TKA and end-stage KBD patients in Tibetan highland areas. The retrospective cohort included 43 KBD patients, comprising a total of 59 knees, who had undergone TKA at West China Hospital, Sichuan University between 2008 and 2021. Patients were subsequently followed up for a minimum of 3 years, and received rigorous radiological and clinical assessments at 3, 6, and 12 months post surgery, followed by annual examinations thereafter. The evaluation included various efficacy indices, including visual analogue scale (VAS) scores, hospital for special surgery (HSS) scores, functional score for adult Tibetans with Kashin-Beck disease (FSAT-KBD), and radiographic findings. Comparison of indicators within the same group was conducted using one-way repeated-measures analysis of variance or paired sample t-tests, whereas between-group differences were compared using an independent t-test. Throughout the average follow-up duration of 10.8 years, patients experienced a substantial reduction in knee pain and noteworthy functional improvement. The VAS scores decreased significantly from 77.47 ± 4.12 mm before surgery to 10.91 ± 1.97 mm after surgery, indicating considerable alleviation of knee pain. The HSS scores improved markedly, increasing from 44.26 ± 4.95 preoperatively to 91.26 ± 4.37, indicating enhanced joint function. Similarly, the FSAT-KBD exhibited positive progression, increasing from 25.90 ± 3.12 to 36.95 ± 3.54. Importantly, at the last follow-up, none of the patients presented with periprosthetic infection, prosthesis loosening, or periprosthetic fracture. At long-term follow-up, compared with patients in the preoperative period, patients in Tibetan highland areas with KBD of the knee who underwent TKA benefited from a significant reduction in pain, improvement in joint function, and satisfactory improvement in quality of life.